• Paediatric fluids
    Link:www.apagbi.org.uk/sites/default/files/Perioperative_Fluid_Management_2007.pdf
    • Changes during childhood
      • Age
        • Preterm neonate
          • Neonate
            • 1y
              • 3y
                • Adult
      • Weight (kg)
        • 1.5kg
          • 3kg
            • 10kg
              • 15kg
                • 70kg
      • BSA
        • 0.15 m²
          • 0.2 m²
            • 0.5 m²
              • 0.6 m²
                • 1.7 m²
      • BSA/weight
        • 0.1
          • 0.07
            • 0.05
              • 0.04
                • 0.02
      • TBW (%)
        • 80%
          • 78%
            • 65%
              • 60%
                • 60%
      • ECF (%)
        • 50%
          • 45%
            • 25%
              • 20%
                • 20%
      • ICF (%)
        • 30%
          • 35%
            • 40%
              • 40%
                • 40%
    • Maintenance fluids
      • 0-10kg
        • 4ml/kg/hr
      • 10-20kg
        • 40ml/hr + 2ml/kg/hr for each kg over 10kg
      • 21-70kg
        • 60ml/hr + 1ml/kg/hr for each kg over 20kg
    • Estimate of blood volume
      • Preterm neonate
        • 90-100ml/kg
      • Term neonate
        • 80-90ml/kg
      • Infant
        • 75-80ml/kg
      • Older children
        • 70-75ml/kg
    • Daily caloric requirement
      • 0-10kg
        • 100kcal/kg
      • 10-20kg
        • 1000kcal + 50kcal/kg for each kg over 10
      • 21-70kg
        • 1500kcal + 20kcal/kg for each kg over 20
    • Electrolyte defecits
      • Defecit (mmol) = weight x (Cd - Cm) x 0.3
      • Cd = desired plasma concentration; Cm = measured concentration
    • Peri-op fluid management
      • Pre-op
        • Defecit prior to surgery = usual hourly fluid rate x number of hours starvation
        • Replace 50% over first 1 hr then other 50% over the next 2 hrs
        • May not be required for majority of fit patients undergoing minor surgery
        • Correct dehydration with Hartmann's or 0.9% saline if presenting for emergency surgery
        • Neonates may need pre-op glucose containing solutions to avoid pre-op hypoglycaemia but this is rare in children
      • Intra-operative losses
        • Intra-abdominal surgery
          • 6-10ml/kg/hr
        • Intra-thoracic surgery
          • 4-7ml/kg/hr
        • Eye/superficial/neuro
          • 1-2ml/kg/hr
        • Replace the above with isotonic fluid
        • Hypotonic fluids should not be used at greater than maintenance rates as a rule
        • Avoid hypotonic fluids if the sodium is below 140
        • Blood
          • Beware hyperglycaemia with large transfusions
      • Replacement post op should be with isotonic fluids, blood or colloid
    • Assessment of dehydration
      • Signs/symp
        • Mild
          • Moderate
            • Severe
      • Wt loss (%)
        • 5 %
          • 10 %
            • 15 %
      • Deficit (ml/kg)
        • 50ml/kg
          • 100ml/kg
            • 150ml/kg
      • Appearance
        • Thirsty, alert
          • Lethargic, pale, rousable
            • Drowsy, comatose, cold, grey
      • Skin turgor
        • Normal
          • Decreased
            • Markedly decreased
      • Fontanelle
        • Normal
          • Sunken
            • Very sunken
      • Membranes
        • Moist
          • Dry
            • Very dry
      • Pulse rate
        • Normal
          • Rapid/weak
            • Rapid & feeble
      • Blood pressure
        • Normal
          • Normal
            • Low
      • Respiration
        • Normal
          • Deep
            • Deep and rapid
      • Urine output
        • < 2ml/kg/h
          • < 1ml/kg/h
            • < 0.5ml/kg/hr
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/3/1/1.full.pdf?sid=9917b8d6-f5fe-4d16-8064-49effef3a567